A large polio vaccination campaign started in war-torn Gaza on Sunday, September 1. The initiative, which is being led by the World Health Organization (WHO), aims to reach over 640,000 children under the age of ten.
To facilitate the vaccinations, Israel has agreed to pause its military operations in the central part of Gaza from 6am to 3pm for three days. Similar pauses are expected to follow for the northern and southern parts of the enclave – also for three days each.
Polio is a highly contagious virus, which is spread between humans and can have life-altering health consequences. It has disappeared in most countries since the introduction of vaccinations. The last case in the UK, for example, was detected in the 1990s.
But the reemergence of polio in Gaza after 25 years without a case shows the dramatic effect war can have on the health of a population.
The war has, on top of inflicting death and injury, disrupted routine healthcare. Many hospitals in Gaza have been destroyed or damaged, and those that are operating lack key staff and supplies. At the same time, about 1.9 million people are internally displaced within Gaza, which has further affected their access to healthcare.
Polio is now being targeted because of the serious danger of a rapid spread in Gaza and beyond. To stop infection outbreaks, at least 95% of children need to be vaccinated. However, the proportion of Gazans who are vaccinated against polio has fallen from 99% in 2022 to 89% today.
There is still no cure for polio, and about one in every 200 people infected will suffer irreversible paralysis. Polio is today endemic in only two countries, Pakistan and Afghanistan. This makes its reemergence in Gaza very significant for the global fight to eradicate the disease.
Around 40% of non- or under-vaccinated children worldwide live in areas affected by conflict. Vaccination campaigns in war zones aid immediate survival, as well as the eventual rebuilding of a healthy society.
However, campaign organisers face many difficulties. And this will be no different in Gaza, where the safety of health workers is being threatened by continuing violence and instability. The conflict has, for example, already claimed the lives of over 500 healthcare workers.
Vaccine logistics can be difficult even outside of conflict areas. Most vaccines have specific conditions under which they need to be transported and stored. The polio vaccine is quickly destroyed in temperatures over 8°C, and requires storage at temperatures between -15°C and -25°C before it reaches healthcare facilities.
To ensure product viability and patient safety, this “cold chain” cannot be disrupted. And necessary refrigeration equipment has been brought into Gaza. However, the transportation and storage of vaccines is being hampered by damaged roads, buildings and power supplies.
A very limited electricity supply and a persistent fuel shortage make it even more difficult to maintain cold storage.
Money and personnel are often extremely limited in conflict zones. This makes buying vaccines, distributing them and training people to administer them difficult. The polio vaccine used in Gaza is given orally, so there is no need for syringes and other supplies to be available at the same time.
As populations in conflict zones are often displaced, it is also very difficult to reach them to ensure complete vaccination coverage. But there are over 400 fixed vaccination sites, such as healthcare centres and field hospitals, where over 2,000 mostly local workers will administer the vaccines. And there are outreach sites in places where people commonly gather.
The pause must hold
An important factor in the success or failure of the polio vaccination campaign in Gaza will be whether the pauses in the fighting hold. Several international organisations have previously paused their operations in the area to protect their workers.
Fighting has only been paused for a part of the day in specific areas of Gaza, so the war continues and there is no permanent ceasefire in sight. If the situation is too dangerous, families will be reluctant to come forward for vaccinations.
Threats do not only come from Israeli military activities. The looting of aid trucks in Gaza has created an increasingly difficult environment as people are desperate for supplies. And disinformation about the safety of the polio vaccine, though swiftly countered, has made some families unsure about the campaign.
A previous “humanitarian pause” in Gaza lasted for four days in November 2023. As there was back then, there is widespread international support for this pause. The United Arab Emirates, for example, has pledged US$5 million (£3.8 million) to support the vaccination campaign.
Coordination of the campaign between Gaza’s health ministry, the WHO, Unicef, Unrwa and others seems to be going smoothly. Thousands of children were vaccinated on the first day. And 1.2 million vaccine doses are in place within Gaza.
To achieve full vaccine protection, children in Gaza will need a second dose of the vaccine within two months of the first. Further pauses in fighting will have to be agreed to facilitate this, and resources to sustain this activity must be marshalled and healthcare workers protected.
It’s important to note that polio is not the only disease experts in Gaza are concerned about. Much of the waste water treatment infrastructure in Gaza has been destroyed, and both diarrhoea and respiratory infections are widespread, especially among young children.
Hunger also exacerbates health issues. And Gaza is facing high levels of food insecurity, with the delivery of goods into the territory still severely restricted.
Outbreaks of infectious diseases like polio have a significant effect on the survival and wellbeing of children and society. The current vaccination campaign in Gaza is thus a critical step.
But only a ceasefire will ultimately make it possible to rebuild crucial infrastructure, such as sewage treatment, to offer healthcare, and to provide enough food and medical supplies to families in Gaza.